When you sit down with a game, you make a pact with it: you’ll push the buttons, and it will show you what happens when you do. A lot of games don’t really care to interrogate what that means, to use the physical realities of the medium to tell a story. Remember having to plug your controller into the second port of your PlayStation to fight Psycho Mantis? That’s rare. Instead, many of them are content to be films where you control the action. Rhythm Doctor is not one of those games.

In the eight or so hours I spent seeing its 1.0 version through to completion, Rhythm Doctor frustrated me, earned some laughs, made me tear up, and used this medium to tell a story in ways I’ve never seen a game do before. It is one of the most difficult rhythm games I’ve ever played, and one I couldn’t put down. Near the end, I felt like I might need a little rhythm therapy myself, a shock to the heart to keep me going. But I wanted to live in that world a little longer, listen to these songs a little more, spend a little more time with these characters. It was worth it. Rhythm Doctor drove me crazy, and I loved it.

In Rhythm Doctor, you are an intern assigned to Middlesea Hospital. You work remotely, so you sit behind a screen and watch what’s happening through the hospital’s cameras. The doctors and patients speak to you, but you cannot respond to them. Well, you can, but they can’t hear the intern. Like you as a player, the intern is part of this world but not of it. A participant, but not a resident. When you see yourself on screen, it is as a long arm hovering over a button. The patients sometimes jokingly call you Doctor Finger. It’s a brilliant bit of “player-as-character” that Rhythm Doctor makes the most of throughout its runtime. That this story features some absolutely gorgeous pixel art spritework is just a bonus.

The simple but extremely effective gimmick here is that Middlesea is experimenting with a new treatment that promotes healing by defibrillating patients’ hearts in time with their heartbeats. Your job is to press the button on the defibrillator in sync with the beat of their heart. That’s it. There is only one button. Press it every 7th beat in time with the patient’s heart. Line the beats up properly, and you’ll cure what ails them.

That might not sound hard, and it isn’t. At least at first. One, two, three, four, five, six, press is easy enough. But then you’ll get to polyrhythms, hemiolas, irregular time signatures, silent beats, the works. Again, all you have to do is press your button on every seventh beat. But it gets challenging quickly. I used to think I was good at rhythm games. I played Guitar Hero and Rock Band on Expert. I used to play a couple different instruments. After playing Rhythm Doctor, I no longer think that. Few games have challenged me like this did.

Sometimes you’ll be treating multiple patients at once, each with their own rhythm, and you’ll have to keep track of them simultaneously. Some may drop in and drop out. The excellent songs their hearts are beating to will abruptly change pace. You may have to hit notes in rapid succession or hold them or match a tempo you’ll hear and then have to reproduce. There is a visual indicator here, but it’s not going to hold your hand or tell you exactly when to press your lone button. You’ll have to keep pace yourself, and overcoming initially brutal levels was a thrill.

Rhythm Doctor will help you out – most levels feature a dedicated tutorial teaching you new concepts, certain beats are often preceded by unique sound effects to let you know they’re coming, and a nice nurse will often call out timing changes with a “Get Set Go!” in time to the beat before the change occurs, but visual prompts are limited. There’s no “fit the note into this handy-dandy slot it's barreling towards” in Rhythm Doctor. You have to keep time. I often found myself tapping my other hand against my thigh, silently counting to seven, or moving my head from side to side to keep time.

And you’ll need to, because Rhythm Doctor likes to mess with you, to use the idea that you’re a guy behind a screen pressing buttons to tell its story. If you’re treating a patient while a virus is messing with your connection, you’ll feel it. There will be static, the beat will be thrown off, and things will pop up or fade out. At one point, a bunch of pop-ups saying “DISTRACTION!” overwhelm your screen. As a player, it’s annoying, especially if you’re somewhat reliant on visual cues. As a storytelling conceit, it’s dynamite. Dealing with that would be difficult and irritating, especially at work! I could practically hear the virus mocking me; J.K. Simmons breathing in my ear. “Not quite my tempo.”

But that’s not the only time Rhythm Doctor pulls this trick. Sometimes, it will shrink your screen and bounce it around to the beat. Once, when Cole, a down on his luck musician with a caffeine addiction, rushes across the screen to get to Nicole, a barista at the hospital’s cafe who he’s grown fond of, the game window travels with him as you struggle to keep up via the hospital’s cameras, going entirely off your monitor before reappearing. Even the songs themselves tell a story: when a patient named Logan has trouble admitting his feelings for another named Hailey, their songs reflect it, and he often loses the beat during that level. As the two get closer across several songs, their heart rates grow closer in time. When he finally summons the courage to make it happen, the track resembles a duet at a Broadway show.

The songs here vary from showtunes to dubstep to techno and everything in-between, and each is used to tell a story like this. Every patient’s unique heart rhythm can and will show up in other tracks as they bond with one another, whether it’s a miner helping an injured baseball player rehab from an injury, an elderly couple at opposite ends of the hospital who long to see one another, or Cole and Nicole hash out their issues through song. In Rhythm Doctor, the music is part of the story. Each track moves the narrative forward, and gets to the heart of who these people are and how they feel about one another. You can treat a lot of things with medicine, but sometimes the only cure for a damaged heart is working through what caused it in the first place. I cared about these characters and their relationships, and I wanted to stick around.

That’s good, because you’ll probably have to. Rhythm Doctor holds you to a high standard. Cs may get you degrees, but you’ll need a B grade or better before you can move on to the next level. That can be a little frustrating if you get stuck, and I’m not ashamed to say I had to turn the difficulty down to clear some of the harder stages. Some even have “Night Shift” versions for an extra challenge and a bit more story, and there are several bonus levels to tackle as well, which are goofy and a lot of fun, like the one where a group of nurses pursues a limousine, kicking away projectiles the limo is hurling at them. Others are just chill vibes where you hang out with the characters.

Through it all, though, you’re reminded that while you’re part of this story, it’s not about you. Without spoilers, there’s a rather touching scene later on that you hear about but don’t witness because you’re busy helping another patient. Almost every other character is there, but you’re helping someone else, and the scene happens without you. You only hear the other characters react to it. On one level, it’s smart commentary on the limitations of being behind a screen and the role of the player; you’re not part of this world physically, not matter how badly you might want to be. Your job is to watch and press buttons. On another, it’s a reminder that no one recovery, no one part of the hospital, and no one patient, is less important than any other. It all matters. And there’s emotional resonance here. When one of Cole’s tracks says “Sometimes I’m angry I’m not doing better than I thought I’d do at this point,” I had to pause the game for a moment. I’ve been there. I understand that feeling. I understood that character, and all his flaws. And I admired his persistence in spite of it all.

Rhythm Doctor also features some shockingly relevant commentary on the state of healthcare and capitalism. As the program you’re part of gains traction, there’s pressure from the hospital’s administrator (and head doctor) to expand it, eventually resulting in layoffs to hospital staff and overworked doctors. After all, why have staff when you can have a miracle treatment an intern in their pajamas can perform from their laptop? You don’t need people, right? Just results. Rhythm Doctor ends about as perfectly as it can given all the plates it’s spinning, but it’s nice that it never pulls punches. Nothing is free; everything has a cost, and that cost might be other people.

If you need a break from the story, there’s also a comprehensive level editor to play with and community tracks to download. I’ll be honest with y’all; I’m not much of a level editor cat, but what I’ve played of the community tracks is genuinely impressive. Rhythm Doctor’s soundtrack is so good that I’ve listened to it in between sessions, but it’s great to see developer 7th Beat Games turn their baby over to the community and say “go nuts.” In a world obsessed with selling you something at every moment, editors like this feel increasingly rare, and I’m glad it’s here.